Abstract
BACKGROUND: Emergency medicine (EM) board certification pass rates have been declining amid a rise in new residency programs-many affiliated with for-profit hospitals or lacking Council of Teaching Hospital (COTH) designation. This study examines how founding year, COTH-status, program length, and hospital ownership relate to board examination performance. METHODS: We conducted an observational cross-sectional analysis of 234 EM residency programs using American Board of Emergency Medicine, Accredidation Council for Graduate MEdical Education, and American Hospital Association data. The primary outcomes were program-level first-time Qualifying Exam (QE) and Oral Certifying Exam (OCE) median pass rates from 2021 to 2023. We examined the associations of pass rates with founding year, primary hospital COTH-status, program length (3 vs. 4 years), and primary hospital ownership. Linear regression models assessed relationships between program characteristics and pass rates. RESULTS: Recently-founded programs (post-2015) had significantly lower board performance, with an 11-percentage point reduction in QE pass rates (p < 0.001) and a 2.6-percentage point reduction in OCE pass rates (p = 0.001). Programs affiliated with COTH hospitals had higher pass rates (QE + 6.1 percentage points, p < 0.001; OCE + 1.6 percentage points, p = 0.001). Three- and four-year programs demonstrated similar board pass rates. In comparison to programs with a for-profit affiliation, EM residency programs with nonprofit and government affiliations were associated with nonsignificantly higher QE pass rates (+ 2.0 percentage points, p = 0.40 and + 4.6 percentage points, p = 0.061, respectively). Nonprofit affiliation was associated with nonsignificantly higher OCE pass rates (+ 2.0 percentage points, p = 0.11). Government affiliation was associated with significantly higher OCE pass rates (+ 2.9 percentage points, p = 0.026). CONCLUSION: Program characteristics significantly affect board examination outcomes for EM residents. Recently founded programs, those lacking COTH designation, or those affiliated with for-profit hospitals may lack essential resources and experience for optimal training. Identifying and supporting the institutional factors that contribute to resident success will be vital to maximizing programs' learning environments.